Quality ManagementMedicaidFebruary 1, 2025

Measurement Year (MY) 2023 NCQA HEDIS and CAHPS quality update for Wellpoint

Each year, we assess the quality of healthcare services and explore opportunities for improvement. This process is part of our Quality Assurance and Performance Improvement (QAPI) program, which includes evaluating the care provided to our members and benchmarking it against best practices to ensure that your services continually meet high standards. This process includes:

  • Member feedback: Distributing surveys to gather direct feedback from members regarding both the health plan and providers helps in identifying areas of improvement and understanding member experiences firsthand.
  • Quality improvement programs: Introducing new programs or enhancing existing ones to support and achieve quality goals that demonstrate a commitment to continuous improvement and member satisfaction.

The National Committee for Quality Assurance’s (NCQA) scores Wellpoint each year, and we are proud to announce that we have achieved a 3.5 Star rating for MY 2023. This rating signifies that our healthcare services meet stringent guidelines and standards set forth by the NCQA. This update shows you certain areas we improved in this year based on the NCQA Healthcare Effectiveness Data and Information Set® (HEDIS) and Consumer Assessment of Healthcare Providers and Systems® (CAHPS) results for MY 2023. 

HEDIS

HEDIS is a tool used to evaluate health plans to measure the quality of care that members receive. The table below illustrates a sample comparison of some healthcare measures over the past two years. An increase in rates indicates that our doctors are effectively working with our members to provide timely and appropriate care and services.

HEDIS results

HEDIS measures

MY2022

MY2023

Controlling Blood Pressure

63.02%

69.59%

Diabetes — HbA1c Control <8%

53.28%

66.42%

Diabetic Eye Exam

49.64%

51.09%

Well Child Visits — First 15 Months of Life

54.68%

58.20%

Child & Adolescent Well Visits

61.42%

63.65%

Prenatal Visits

90.02%

89.29%

CAHPS member satisfaction survey

Through our annual CAHPS member satisfaction survey, we gather valuable insights on how we can enhance our members satisfaction and service experiences. Member surveys are mailed every January, and the survey covers a range of topics to comprehensively assess members feedback on:

  • How pleased you are with your health plan.
  • How pleased you are with the services you receive.
  • How easy it is to get care.
  • How easy it is to communicate with your doctor.

The table below compares a sample of category ratings from the adult CAHPS survey results over the past two years:

Adult CAHPS survey results

Survey topic

MY 2022

MY 2023

Getting care quickly

83.22%

78.80%

Getting care easily

82.08%

80.43%

Rating of health plan

83.38%

77.03%

Rating of personal doctor

87.37%

89.95%

Rating of all healthcare

72.58%

74.36%

The table below compares a sample of category ratings from the child CAHPS survey results over the past two years:

Child CAHPS survey results

Survey topic

MY 2022

MY 2023

Getting care easily

77.99%

80.90%

Getting care quickly

85.92%

88.46%

Rating of health plan

65.07%

83.67%

Rating of personal doctor

70.65%

81.62%

Rating of all healthcare

82.31%

88.79%

Based on the feedback from the adult and child CAHPS surveys, we have identified key areas to focus on for continuous improvement:

  • Improving appointment times and availability including member access to necessary care, tests, and treatments
  • Improving customer service information and tools
  • Improving member engagement for survey response rates

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Coverage provided by Wellpoint New Jersey, Inc. or Wellpoint Insurance Company.

NJWP-CD-074858-24

PUBLICATIONS: February 2025 Provider Newsletter